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https://hdl.handle.net/2144/12100

Abstract

PURPOSE: Despite evidence that residue is the most significant problem separate from aspiration in dysphagia patients with head and neck cancer (HNC) post-radiation (Agarwal, et al., 2011), there is currently no standardized scale with which to rate residue. The purpose ofthis project is to assess the Boston Residue and Clearance Scale (BRACS), which has previously undergone initial reliability and validity testing, for criterion validity with HNC patients.
METHODS: BRACS is an 11-point multidimensional scale developed to determine the severity of residue as detected during a Flexible Endoscopic Evaluation of Swallowing (FEES). The BRACS score is uniquely derived from three aspects: 1) amount and location of residue, 2) presence of spontaneous clearing swallows, and 3) efficacy of clearing swallows. Excellent inter-rater and test-retest reliability, internal consistency and concurrent validity were confirmed by preliminary data (Kaneoka, 2013). In order to further validate BRACS by confirming its criterion validity with HNC patients post-radiation, BRACS scores were compared to scores on other previously validated measures of dysphagia severity: 1) degree of penetration/aspiration via scores on the Penetration-Aspiration Scale (PAS; Rosenbek, et al., 1996), 2) quality-of-life impairment via scores on them. D. Anderson Dysphagia Inventory (MDADI; Chen, et al., 2001), and 3) diet status via scores on the Performance Status Scale for Head and Neck Cancer-Normalcy ofDiet scale (PSSHNC-ND; List, et al., 1990). Nine patients post-radiation at Boston Medical Center who have a history but are currently free of HNC underwent a FEES exam and completed the MDADI and PSSHNC-ND scales. During the FEES, patients were presented with boluses of liquid, applesauce, and cracker as tolerated. Each of the 24 total collected swallows were reviewed and assigned a PAS and BRACS score by an expert clinician. Using Spearman's rank correlation coefficient, all variables were analyzed for significant associations. Discriminant analyses were also conducted between the scores to determine how accurately different combinations of variables were able to predict diet status on the PSSHNC-ND scale. [TRUNCATED]